大病保险对农村居民医疗费用负担及其公平性影响
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摘要
目的:评估大病保险对宁夏农村居民医疗费用负担及其公平性影响,为完善大病保险提供合理的政策建议。方法:利用宁夏农村地区入户调查数据,模拟比较大病保险报销前后居民自付费用水平、家庭灾难性卫生支出发生风险及其在人群中分布的变化。结果:大病保险有效降低了住院自付费用及家庭灾难性卫生支出的发生风险,有助于医疗费用负担的减轻;但从分布来看,大病保险报销虽然改善了人群中自付费用的分布,但也出现了灾难性卫生支出的发生更向贫困家庭集中的趋势。结论:针对目标人群,大病保险政策效果较为显著,但需要进一步完善基本医疗保险制度,做好大病保险政策与其他医疗保障政策的衔接,全面发挥多层次医疗保障体系的作用,并加大消除贫困政策力度,以此减少人群中特别是贫困家庭的医疗费用负担及其发生灾难性卫生支出的风险。
Objective: To evaluate the effect of the catastrophic health insurance on the intensity and equity of rural residents' medical expenses burden in Ningxia. Methods: Based on the household survey data of Ningxia rural areas, stimulation of catastrophic health insurance and prediction of its effect on medical financial burden and equity was performed. Results: Catastrophic Health Insurance effectively reduced inpatients' out-of-pocket(OOP) health expenditure and the risk of household catastrophic health expenditure, which mitigated the burden of medical expenses. Although the incidence of catastrophic medical insurance reimbursement improved the distribution of OOP, the catastrophic health insurance was relatively more concentrated in poorer households. Conclusion:The effect was relatively remarkable for the target group. The policy deserved to be extended to a certain extent, simultaneously made a good performance of the convergence of catastrophic health insurance and other medical insurance policy, decreased the medical expense burden(especially among the poor families) and the risks of of catastrophic medical insurance.
Objective: To evaluate the effect of the catastrophic health insurance on the intensity and equity of rural residents' medical expenses burden in Ningxia. Methods: Based on the household survey data of Ningxia rural areas, stimulation of catastrophic health insurance and prediction of its effect on medical financial burden and equity was performed. Results: Catastrophic Health Insurance effectively reduced inpatients' out-of-pocket(OOP) health expenditure and the risk of household catastrophic health expenditure, which mitigated the burden of medical expenses. Although the incidence of catastrophic medical insurance reimbursement improved the distribution of OOP, the catastrophic health insurance was relatively more concentrated in poorer households. Conclusion:The effect was relatively remarkable for the target group. The policy deserved to be extended to a certain extent, simultaneously made a good performance of the convergence of catastrophic health insurance and other medical insurance policy, decreased the medical expense burden(especially among the poor families) and the risks of of catastrophic medical insurance.
引文
[1]中国保险监督管理委员会.我国重大疾病保险的行业规范正式启用[EB/OL].(2007-04-30)[2018-10-16].http://www.circ.gov.cn/web/si te0/tab5207/info44715.htm.
[2]宁夏回族自治区人民政府办公厅.关于印发开展城乡居民大病保险工作实施意见的通知[EB/OL].(2013-07-18)[2018-10-16].http://www.nx.si.gov.cn/zcfg/cxjmdbbj/3463.htm.
[3]XU K.Distribution of health payments and catastrophic expenditures methodology.Geneva:Department of Health System Financing[R].Geneva:World Health Organization,2005.
[4]XU K,EVANS D B,KAWABATA K,et al.Household catastrophic health expenditure:a multi country analysis[J].The lancet,2003,362(9378):111-116.
[5]XU K,EVANS D B,CARRIN G,et al.Protecting households from catastrophic health spending[J].Health affairs,2007,26(4):972-983.
[6]陶四海,赵郁馨,万泉,等.灾难性卫生支出分析方法研究[J].中国卫生经济,2004,23(4):9-11.
[7]万泉,翟铁民,赵郁馨.我国部分地区卫生筹资负担公平性研究[J].中国卫生经济,2009,28(7):14-16.
[8]王超群,刘小青,刘晓红,等.大病保险制度对城乡居民家庭灾难性卫生支出的影响--基于某市调查数据的分析[J].中国卫生事业管理,2014(6):433-436.
[9]闫菊娥,闫永亮,郝妮娜,等.三种基本医疗保障制度改善灾难性卫生支出效果实证研究[J].中国卫生经济,2012,31(1):26-28.
[10]李昱,孟庆跃.医改前后农村老年家庭灾难性卫生支出状况分析[J].中国卫生经济,2015(1):45-47.
[11]陈仰东.全面发挥医保在防范因病致贫中的作用[J].中国医疗保险,2016(2):29.
[2]宁夏回族自治区人民政府办公厅.关于印发开展城乡居民大病保险工作实施意见的通知[EB/OL].(2013-07-18)[2018-10-16].http://www.nx.si.gov.cn/zcfg/cxjmdbbj/3463.htm.
[3]XU K.Distribution of health payments and catastrophic expenditures methodology.Geneva:Department of Health System Financing[R].Geneva:World Health Organization,2005.
[4]XU K,EVANS D B,KAWABATA K,et al.Household catastrophic health expenditure:a multi country analysis[J].The lancet,2003,362(9378):111-116.
[5]XU K,EVANS D B,CARRIN G,et al.Protecting households from catastrophic health spending[J].Health affairs,2007,26(4):972-983.
[6]陶四海,赵郁馨,万泉,等.灾难性卫生支出分析方法研究[J].中国卫生经济,2004,23(4):9-11.
[7]万泉,翟铁民,赵郁馨.我国部分地区卫生筹资负担公平性研究[J].中国卫生经济,2009,28(7):14-16.
[8]王超群,刘小青,刘晓红,等.大病保险制度对城乡居民家庭灾难性卫生支出的影响--基于某市调查数据的分析[J].中国卫生事业管理,2014(6):433-436.
[9]闫菊娥,闫永亮,郝妮娜,等.三种基本医疗保障制度改善灾难性卫生支出效果实证研究[J].中国卫生经济,2012,31(1):26-28.
[10]李昱,孟庆跃.医改前后农村老年家庭灾难性卫生支出状况分析[J].中国卫生经济,2015(1):45-47.
[11]陈仰东.全面发挥医保在防范因病致贫中的作用[J].中国医疗保险,2016(2):29.